Laparoscopy for Endometriosis

I just recently had a laparoscopy done to determine once and for all if I have endometriosis. I’ve been having severe pelvic pain to the point that I required Vicodin to function on my worse days (usually during a period). I thought it would be interesting to have a post talking about what it is and how it’s supposed to help treat endometriosis. In my case, they found one small lesion, two hernias, and had to remove my appendix. Awesome, right? But every person is different!

Overview of the procedure

Laparoscopy is usually done under general anaesthesia. Generally, a small incision is made near the belly button and the abdomen is filled with CO2 gas. This lifts the abdomen away from the internal organs, giving the surgeon a better view. The lighted laparoscope is then inserted into the abdomen. Two other small incisions may be made in the abdomen so additional surgical instruments, such as a probe to move organs, can be used during the surgery. Many surgeons also attach a video camera to the laparoscope to enlarge the view, allowing the entire surgical team to see the procedure.

During the laparoscopy, the doctor examines the pelvic organs, looking for obvious and atypical endometriosis lesions as well as endometriomas (endometriosis-filled cysts), adhesions, and scarring. Depending on your history and symptoms, the doctor may also look for fibroid tumours or other abnormalities. Other procedures, such as a hysteroscopy (an examination of the inside of the uterus) may also be performed.

Diagnosis and treatment of endometriosis may take place during the same procedure. Your doctor may also remove the lesions to send to a lab for biopsy. This will document the presence or absence of endometriosis.

What is Endometriosis?

Endometriosis affects an estimated 176 million women worldwide regardless of their ethnic and social background. Many remain undiagnosed and are therefore not treated.

Endometriosis is a condition where tissue similar to the lining of the uterus (the endometrial stroma and glands, which should only be located inside the uterus) is found elsewhere in the body [1].

It is generally acknowledged that an estimated 10% of all women during their reproductive years (from the onset of menstruation to menopause) are affected by endometriosis [2]. This equates to 176 million women throughout the world, who have to deal with the symptoms of endometriosis during the prime years of their lives [3].

Endometriosis lesions can be found anywhere in the pelvic cavity:

  • on the ovaries
  • the fallopian tubes
  • on the pelvic side-wall (peritoneum)
  • the uterosacral ligaments,
  • the cul-de-sac,
  • the Pouch of Douglas
  • the rectal-vaginal septum

In addition, it can be found in:

  • caesarian-section scars
  • laparoscopy/laparotomy scars
  • on the bladder
  • on the bowel
  • on the intestines, colon, appendix, and rectum.

But these locations are not so common.  In even more rare cases, endometriosis has been found inside the vagina, inside the bladder, on the skin, in the lung, spine, and brain.

Symptoms of endometriosis

The most common symptom of endometriosis is pelvic pain.

The pain often correlates to the menstrual cycle, but a woman with endometriosis may also experience pain that doesn’t correlate to her cycle – this is what makes this disease/condition so unpredictable and frustrating.

For many women, the pain of endometriosis is so severe and debilitating that it impacts their lives in significant ways.

Endometriosis can also cause scar tissue and adhesions to develop that can distort a woman’s internal anatomy. In advanced stages, internal organs may fuse together, causing a condition known as a “frozen pelvis.” This is not common, but it does happen.

It is estimated that 30-40% of women with endometriosis may not be able to have children.

If you, or someone you care about, has endometriosis, it is important to research the disease as much as possible. Many myths and misconceptions about endometriosis still persist, even in the medical literature.

For many women, management of this disease may be a long-term process. Therefore, it is important to educate yourself, take the time to find a good doctor, and consider joining a local support group.

References
  1. Kennedy S, et al. ESHRE guideline for the diagnosis and treatment of endometriosisHuman Reprod 2005;20(10):2698-2704.
  2. Rogers PA, et al. Priorities for endometriosis research: recommendations from an international consensus workshop. Reprod Sci 2009;16(4):335-46.
  3. Adamson GD, et al. Creating solutions in endometriosis: global collaboration through the World Endometriosis Research Foundation. J of Endometriosis 2010;2(1):3-6.

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